LB01 | VONOPRAZAN VS. PANTOPRAZOLE IN PREVENTION OF POST ENDOSCOPIC VARICEAL LIGATION ULCER/BLEEDING IN PORTAL HYPERTENSION: A RANDOMIZED CONTROLLED TRIAL

advanced age, male gender, total withdrawal time and endoscopist experience. Conclusion: The use of real ‐ time CADe during colonoscopies in endoscopists ‐ in ‐ training could increase the overall ADR, especially for small ‐ to ‐ medium size adenomas, in different levels of experience (ClinicalTrials.gov number: NCT04838951). Disclosure: This study received research grant

systemic inflammatory response. We aimed to test the hypothesis that a procalcitonin-based algorithm to guide initiation, continuation, and discontinuation of antibiotics could lead to reduced antibiotic use without an adverse effect on outcome in acute pancreatitis.
Aims and Methods: PROCAP was a single-centre, patient-blinded, randomised controlled trial done at the Manchester Royal Infirmary (Manchester, UK). Eligible participants were aged 18 years or older and had a clinical diagnosis of acute pancreatitis. Participants were randomly assigned (1:1) to procalcitonin-guided care or usual care using web-based randomisation software. The randomisation sequence was stratified by disease severity and admission pathway, using variable block sizes of 4, 6, or 8. Patients, but not clinicians, were masked to group assignment. In the procalcitonin-guidedcare group, procalcitonin testing was conducted on days 0, 4, 7, and weekly thereafter. Guidance was to stop or not start antibiotics following a test value of <1.0 ng/ml and to start or continue antibiotics following a test value of 1.0 ng/ml or more. In the intervention group, any empirical clinical decision to use antibiotics was preceded by measurement of procalcitonin. Otherwise, both groups received standard care. The primary outcome was use of antibiotics during the index admission to hospital. All analyses were done in the intentionto-treat population. This study was registered with the International Standard Randomised Controlled Trial registry, ISRCTN 50584992.
Results: Between 29 July 2018, and 13 November 2020, 369 patients were screened, of whom 260 were enrolled and randomly assigned to a treatment group (132 to procalcitonin-guided care and 128 to usual care). 59 (45%) of patients in the procalcitonin-guided care group were prescribed antibiotics compared with 79 (63%) in the usual care group (adjusted risk difference −15.6% [95% CI -27.0 to −4.2]; p = 0.0071). The odds ratio for the treatment effect was 0·49 (95% CI 0.29-0.83; p = 0.0077). There was no significant difference between groups in terms of the number of clinical infections or hospital-acquired infections per patient. Four (3%) patients in the procalcitonin-guided care group and three (2%) patients in the usual care group died; all deaths were related to underlying severe pancreatitis. There was no difference in adverse events between the groups. Results: Based on the time of documentation of diagnosis, the mean age in the paediatric and adult cohort was 8 and 63 years respectively.

Conclusion
The study population was gender balanced in the paediatric cohort (M: F, 52%:48%). In comparison, there was a male preponderance among adults (F: across severity groups 36%-43%), with both cohorts showing dominance of white race (paediatric: 65% and adult: 71%). The most commonly occurring prespecified diagnosis in the paediatric cohort was biliary atresia (23%), followed by primary sclerosing cholangitis (associated in 14%). In the adult cohort, alcoholic liver disease was the most common aetiology (across all severity groups), and was most prevalent in patients who had a VH, followed by chronic viral hepatitis, and non-alcoholic steatohepatitis. In the paediatric cohort, 33.8% of patients developed VH, 15.9% had VBL and 26.3% underwent liver transplant. Based on a composite of all events of interest (attained in approximately 50% patients), 24-month survival probability estimate was below 70% in patients developing VH without intervention. In comparison, in the adult cohort, cumulative event rate for VH alone was over 60%. The composite event rate of liver outcomes and death approached 75% and 20% in patients with or without VH respectively, and notably more than half of this incidence was achieved within the first 6 months.

Conclusion:
In this large real world data, the prognosis of pHTN was poor in both paediatric and adult populations, despite different aetiologies. The very high rates of mortality and morbidity despite currently employed interventions such as beta-blockers, VBL and Today's population frequency of rs11209026-A shows a North-South and East-West gradient that reflects penetration of the Steppe population into Europe but also parallels today's gradient in the incidence of IBD.

T A B L E 1 (Continued)
CADe group (n = 386) Control group (n = 380)  (1,2). Breakthrough infection is more common in IBD patients receiving infliximab compared to vedolizumab after two vaccine doses (2). There are limited data on humoral and cell-mediated anti-SARS-CoV-2 immunity in patients with IBD compared to non-immunosuppressed healthy controls after three COVID-19 vaccine doses.  were independently associated with higher and lower anti-S1

Aims and Methods
antibody concentrations respectively. However, antigen specific T cell responses were similar in IBD patients in all treatment groups studied, except for recipients of tofacitinib without evidence of previous infection, where T cell responses were significantly reduced relative to healthy controls (p = 0.021). Financial support was provided as a Research Grant by Pfizer